HomeMy WebLinkAboutPermit Sidewalk 1991-3-3
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REiMDENTIAL - COMMER~L
-. SIDEWALK / CUReCUT .
APPLICATION / PEI<MIT
SPRINGFIELD
22!'> NORTH FIFTH STREET
SPRINGFIELD. OREGON <31411
ENGINEERING DIVISION
OFFICE NO. 126-;l1!,>;I
INSPECTION LINE, 126-;116<3
JOB ADDre66s 75t.{. ~Am( L..<tDN
ASSESSORS MAP NO.*';, D~ ~~ 17 _ TI>:X LOT NO. 'f tFt(}T)
euElDIVISION, "f2.?u f).J {L.~ J-h LA......
OUNER,
RECEIPT ~ I C{ 4 S' 0
CASH 4
CHECK _
ADDRESS,
Cln.,
'f
CHECKED FOR DELINQUENCIES _
STATE,
ZIP,
PHONE NO.
WOIOiK DE6CFi!IPTION,
SIDEWALK, ~ CURe SIDE _
CURe-CUT, X RESIDENTIAL _
!lECOND DRIVEWAY (SEE TRAFFIC)
REQUIRES APPLICATION FOR A !lECOND DRIVEWAn.,.-4.1a)
OR A COUNTY APPLICATION FOR FACILITY PEI<MIT (C '38-210;1)
IF IN THE U6.El.
SETElACK _
COMMERICAL _
DATE OF APPLICATION
~. \-1:;,.4' I
SIGNED,
DATE,
~,
r~ \'L-, Oil
WOfi!K TO BE F'E1O!fi..,~ "=0 BY, OUNER X. CONTRACTOR
CONTRACTOR*' :(R:'Q)l3ZI{.J(, ~~ol-iS\. REGISTRATION NO.*'
ADDRE55 (n7(" AUf,li ?A-r<K ST ~e~ Q'140z.
EXPIRES, ~/'f I
PI-lONE, hAC( """"t.(.B
........""".....lJl'!E FOR IN&FECTloN reGlUEST.
CALL 126-;11&<3 (RECORDER) STATE YOUR CITY DESIGNATED JOEl NUMElER, JOel ADDRESS,TYPE OF
INSPECTION REQUESTED AND WHEN YOU WILL ElE READY FOR INSPECTION. CONTRACTORS OR OUNERS NAME AND
PI-lONE NUMElER REQUESTS RECEIVED ElEFORE 1,tZ><Z> AM WILL ElE MADE THE SA"1E DAY. REQUESTS AFTER 1,tZ><Z>
AM WILL ElE MADE THE NEXT UJOf<l<.ING DAY
*' !lEE ElOOK
EXISTING ElUILDIN(; Pl:I<MIT NO. (. IF APPLICAElLE )
YOUR CITY DESI~ATED JOEl NO. Isf q, 0 -Z ,0]
, ,
reQUireD IN&FECTIONS
D
SIDEWALK / DRIVEWA"-
FOR ALL CONCRETE PAYING WITHIN
THE STREET RIGHT OF WA"-, TO ElE
MADE AFTER ALL EXCAYATING
IS COMPLETE AND FORM UJOf<l<.
AND euEl-ElA!lE MATERIAL IS
IN PLACE
~
CURe / APPROACH APRON,
AFTER FOI<MS ARE ERECTED
ElUT PRIOR TO POURING
CONCRETE.
FEES. SIDEWALKS. CURB-CUT WALK X'
.10.00 . W.l5/LF. ( X ) .10.00 . W.l5/LF. ( X ) / ""
OF WALK
\ /5 COMMERICAL DRIVEWAYS eHALL I, X' I.
HAVE !'>' TO e' FLAIRS
. ()- ;1'- 10" STANDARD 'I 'J
TOTALFEfOMIT FEE,
I HAVE CARERJLLY EXAMINED THE COMPLETED APPLICATION FOR PEI<MIT, AND DO HEREEl"- CERTIFY THAT ALL
INFOI<MATlON HEREON IS TRUE AND CORRECT, AND I RJRTHER CERTIFY THAT AN.,- AND ALL WORK PERFOI<MED
eHALL BE DONE IN ACCORDANCE WITH THE ORDINANCES OF THE CITY OF SPRINGFIELD, AND THE LAW5 OF THE
STATE OF OREGON PERTAINING TO THE WORK DE5CRIBED HEREIN, AND THAT NO OCCUPANCY WILL ElE MADE
OF ANY STRUCTURE WITHOUT PEI<MIMION OF THE ElUILDING DIVISION. I FURTHER CERTIF'r THAT ONLY CONTRACTORS
AND EMPLOYEES WHO ARE IN COMPLIANCE WITH ORS 1101.IO!;!,> WILL ElE USED ON THIS PROJECT.
4-J~12r~ ~1(~lq(
SIGNED DATE '